Variability in Care Management Programs in Medicare ACOs: A Survey of Medical Directors

Disparities in the Use of In-Person and Telehealth Primary Care Among High- and Low-Risk Medicare Beneficiaries During COVID-19

“…The study sample was further stratified into a high-risk group of Medicare beneficiaries whose Hierarchical Condition Category (HCC) scores were 2 or higher, and a low-risk group of those with HCC scores less than 2. Our stratification selection is supported by the fact that high- and low-risk patients have very different care utilization patterns due to medical needs, and the high-risk population is always a targeted subgroup for care management in the ACO for quality improvement and cost control purposes ( 33 , 34 ). In addition, due to the difference in baseline utilization, high- and low-risk groups may also experience different pandemic impacts on care utilization ( 14 , 17 ).…”

“…Two primary outcomes were analyzed in the study: (1) the change in outpatient primary care (in-person and telehealth) visits and (2) the use of telehealth in the pandemic cohort relative to the control cohort during the 6-month study period. For each outcome, we analyzed ACO system-wide aggregated outcomes by month and then performed a beneficiary-level regression analysis stratified by risk group (14,17) (33,34).…”

Association Between Care Management and Outcomes Among Patients With Complex Needs in Medicare Accountable Care Organizations

“…Both care management, which refers to programs and systems that aim to help manage patients’ health and medical conditions, and care coordination, which refers to activities to integrate care across practitioners, require organizational investments because the associated services typically cross boundaries of professions and settings. Despite ongoing investment in care management and coordination programs by ACOs, 6,7 there is little empirical research examining the heterogeneity across ACOs in these activities or the association of those activities with outcomes.…”

Care Management For Older Adults: The Roles Of Nurses, Social Workers, And Physicians

“…Early care management programs focused on patients who used a high volume of services or whose care was in the highest tier of costs, especially frail older adults who are at increased risk for poor health outcomes, hospitalization, falls with injury, and mortality and others with complex comorbid medical conditions. [2][3][4][5] Health systems have also had increased incentives to develop or contract with such programs in an era of bundled and other value-based payment systems. Recent reports indicate that most accountable care organizations (ACOs) and certified patient-centered medical homes now include some sort of care or case management.…”

“…[9][10][11][12] In one study of fifteen ACOs, all but one of them included RN care managers, while eleven had social workers and nine had navigators or community health workers. 5 Demonstrating cost savings in care management programs has been challenging: Savings are typically thought to come with decreased use of emergency and hospital services, but programs may be labor and staffing intensive. Still, many care management programs have clear benefits for patients in managing care arrangements; assisting with care coordination at transitions in care; and providing behavioral, educational, and community resource supports.…”